Can Swelling After Blepharoplasty Be Permanent?

Question

I had lower blepharophasty  Nov 10, but since the one eye stayed swollen the doctor opened it up again to see if any was wrong on Dec 23. He claimed that the muscle had slightly folded on itself and he straightened it out. So, it's four weeks today, and  it's still swollen each morning with makes that circular indentation where the puffiness meets the eye socket and makes me feel like a freak.
Last night it actually looked better, but today when I woke up it was more swollen than ever and it has remained swollen today. I have hardly left the house for the past two months, as I am so self conscious. Evenings are a little better, but I still don't feel like me and I keep wondering if people are noticing it since it can look better or worse depending on the lighting. The other healed in two weeks. Could this problem be permanent?

Kenneth D. Steinsapir, MD · Answer

With rare exceptions, swelling caused by eyelid surgery resolves in time.  Four weeks after a surgery is actually considered to be relatively soon after surgery.  This means that the swelling you are experiencing will get better in time.  The rare circumstances where swelling lingers can be related to surgical disruption to the eyelid lymphatics but even this type of swelling resolves eventually. 
However, there other causes of fullness following eyelid surgery that are unrelated to tissue swelling.  This can include fullness from tissue that can become heaped or wadded with surgery.  This can be seen for example after fat transfer to the lower eyelid.  You indicate that your surgeon straighten out muscle in the eyelid.  Again this might heal in such a way that the eyelid contour is not even or smooth and initially is seen with tissue swelling as general fullness.  These types of issues generally benefit from 6 to 12 months of healing and whatever has not fully resolved at the point may need to be addressed with revisional surgery.
Finally, ask yourself if what is concerning you is your confidence in your surgeon or the office.  Sometime offices (and their doctors) don't give patients the opportunity to voice their concerns about the surgical results.  The doctor or staff know that almost everything gets better in time and the goal is simply to give you time for that recovery.  However, they still need to listen to your concerns.  Often second opinion in this time frame are not very productive for the simple reason that what is needed is time.  However, if you are truly concerned and feel that your concerns are not being addressed, a second opinion may be useful.

James R. Gordon, MD, FACS, FAAO · Answer

Usually the swelling following eyelid surgery greatly improves within 3 weeks. It often persists and fluctuates for many months. Be patient because it should fully resolve. If you are concerned, see your surgeon for an evaluation.

Richard J. Bruneteau, MD · Answer

Eyelid
swelling is extremely common following blepharoplasty. Following surgery, the
majority of the swelling has disappeared in about a week, but small amounts may
persist for up to a month. In patients who have had revisional surgery swelling
may last for longer periods of time.

The
swelling is typically worse in the morning, after lying down all night. It
tends to improve during the day when the patient is in the upright position.

It
appears that this type of severe swelling would be anticipated following
revisional surgery. For this reason it may last longer than normal but would
not be a permanent problem. Elevating your head and using ice compresses might accelerate your recovery. If the swelling fails to
improve, make sure you discuss the issue with your plastic surgeon.

Philip S. Schoenfeld, MD, FACS · Answer

Dear Hollygirl,
Swelling following lower lid blepharoplasty is not particularly uncommon.  If the muscle had folded upon itself it sounds like your surgeon performed a subciliary incision to the lower lid.  This approach can address the fat and excess skin and muscle of the lower lid, but, the approach does require an incision and more dissection to the area.   
Too much fat removal or improper fat repositioning may also give areas of the lower lid a puffy or hollow appearrance.  Surgery in this area will disrupt the lymphatic system of the lower lid and can take several weeks before it is reestablished and morning swelling will resolve.  
I am sure your surgeon weighed all of their options carefully, but, reoperating in such a short period of time does not give the tissue adequate time to naturally heal. 
Your postoperative edema may have subsided spontaneously, but, now you will have to wait for the effects of the second surgery to subside.  Time and patience may be all that are required to enable you to achieve the result you were hoping for, but, a conservative steroid  injection to the area of concern may help to expedite the outcome.

John J. Edney, MD · Answer

Swelling after a blepharoplasty is affected by several
factors.  The type of procedure
performed and the manner in which is it performed can have a significant effect
on postoperative swelling.  If the
operation is performed by a well-trained and experienced surgeon, then the
trauma involved with the procedure should be kept to a minimum, thus helping
reduce postoperative swelling. 
Some eyelid procedures are more complex than others.  The more internal trauma that occurs,
the more the effect on postoperative swelling.   Normally, this swelling will be significantly
diminished within the first month after surgery.  Some patients may take several months to have resolution of
the swelling.  Commonly, these
patients exhibit significant swelling or puffiness in their eyelids prior to
the procedure.

In order to diminish the
swelling, it is important to follow the directions of your plastic
surgeon.  Normally, this includes
some cold compresses in the immediate postoperative period, elevation of the
head until swelling subsides, and avoiding any type of activity that is
strenuous enough to make your face turn red.

In some patients, though this may
take longer than normal, swelling is not permanent.

Can Swelling After Blepharoplasty Be Permanent?

Answers (12)

Answer: No but it can take a long time for all swelling to resolve.

Answer: No but it can take a long time for all swelling to resolve.

Answer: Persistent swelling

Answer: Persistent swelling

Answer: Swelling May Persist For Up To A Month Following Blepharoplasty

Answer: Swelling May Persist For Up To A Month Following Blepharoplasty

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Can Swelling After Blepharoplasty Be Permanent?

Answers (12)

Answer: No but it can take a long time for all swelling to resolve.

Answer: No but it can take a long time for all swelling to resolve.

Answer: Persistent swelling

Answer: Persistent swelling

Answer: Swelling May Persist For Up To A Month Following Blepharoplasty

Answer: Swelling May Persist For Up To A Month Following Blepharoplasty

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Answer: Time and patience may be all that are required.

Answer: Time and patience may be all that are required.

Answer: Swelling Following Eyelid Surgery

Answer: Swelling Following Eyelid Surgery

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